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Home My WebLink About247348 07'/15/15 C*q CITY OF CARMEL, INDIANA VENDOR: 367222 4 ® ONE CIVIC SQIU HEALTH WORKPLACE SERVICES LLCCHECK AMOUNT: $*�**44,825.82* CARMEL, INDIANA 46032 2046 RELIABLE PKWY CHECK NUMBER: 247 348 +M«oN CHICAGO IL 60686-0020 CHECK DATE: 071 15/15 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 301 50 3990 742482 4,374.16 OTHER EXPENSES 1201 438800 742554 75.00 TESTING FEES 301 50F3990 742766 28,394.00 OTHER EXPENSES 1120 430701 743001 150.00 MEDICAL EXAM FEES 301 5023990 743001 9,702.20 OTHER EXPENSES 301 503990 743002 1,424.86 OTHER EXPENSES 1205 4317500 743083 705.60 GENERAL INSURANCE i I Indiana University Health Workplace Services, LLC -30l 950 North Meridian Street Suite 950 (City of Carmel) Indianapolis, IN 46204 317-963-1535 Tax ID# 20-0994452 Invoice June 30, 2015 Bill to: Barbara Lamb For: City of Carmel-Onsite City of Carmel-Onsite Staff Time/June 2015 1 Civic Square Carmel,IN 461032- Invoice# 742766 Service Date Description Quantily Charae Recei Ad'us Balance 06/01/2015 MD Staff Time 5.00 875.00 875.00 Dr.Fagan 06/01/2015 M.A.Staff Time 6.00 168.00 168.00 Kimberly Pride 06/01/2015 R.N.Staff Time 6.00 372.00 372.00 Mareesa Martin 06/02/2015 MD Staff Time 6.00 1,050.00 1050.00 Dr.Fagan 06/02/2015 M.A.Staff Time 6.50 182.00 182.00 Kimberly Pride 06/02/2015 R.N.Staff Time 6.50 403.00 403.00 Mareesa Martin 06/03/2015 MD Staff Time 5.00 875.00 875.00 Dr.Fagan 06/03/2015 M.A.Staff Time 5.50 154.00 154.00 Kimberly Pride 06/03/2015 R.N.Staff Time 5.50 341.00 341.00 Mareesa Martin 06/04/2015 MD Staff Time 4.00 700.00 700.00 Dr.Fagan 06/04/2015 M.A.Staff Time 4.50 126.00 126.00 Kimberly Pride 06/04/2015 R.N.Staff Time 4.50 279.00 279.00 Mareesa Martin 06/05/2015 N.P.Staff Time 5.00 560.00 560.00 Andrea Opsal 06/05/2015 M.A.Staff Time 5.50 154.00 154.00 Kimberly Pride 06/05/2015 R.N.Staff Time 5.50 341.00 341.00 Mareesa Martin 06/08/2015 MD Staff Time 5.00 875.00 875.00 Dr.Fagan Submitted To JUL 13 2015 Clea Tre surer Invoice# 742766(continued)page 2 I Service Date Description Quanti Charge Recei Ad"Us Balance 06/08/2015 M.A.Staff Time 5.50 154.00 154.00 Kimberly Pride 06/08/2015 R.N.Staff Time 5.50 341.00 341.00 Mareesa Martin 06/09/2015 MD Staff Time 6.00 1,050.00 1050.00 Dr.Fagan 06/09/2015 M.A.Staff Time 6.50 182.00 182.00 Kimberly Pride 06/09/2015 R.N.Staff Time 6.50 403.00 403.00 Mareesa Martin 06/10/2015 N.P.Staff Time 5.00 560.00 560.00 Andrea Opsal 06/10/2015 M.A.Staff Time 5.50 154.00 154.00 Kimberly Pride 06/10/2015 R.N.Staff Time 5.50 341.00 341.00 Mareesa Martin 06/11/2015 MD Staff Time 4.00 700.00 700.00 Dr.Fagan 06/11/2015 M.A.Staff Time 4.50 126.00 126.00 Kimberly Pride 06/11/2015 R.N.Staff Time 4.50 279.00 279.00 Mareesa Martin 06/12/2015 MD Staff Time 5.00 875.00 875.00 Dr.Fagan 06/12/2015 M.A.Staff Time 5.50 154.00 154.00 Kimberly Pride 06/12/2015 R.N.Staff Time 5.50 341.00 341.00 Mareesa Martin 06/15/2015 R.N.Staff Time 5.50 341.00 341.00 Mareesa Martin 06/15/2015 M.A.Staff Time 5.50 154.00 154.00 Kimberly Pride 06/15/2015 MD Staff Time 5.00 875.00 875.00 Dr.Fagan 06/16/2015 R.N.Staff Time 7.50 465.00 465.00 Mareesa Martin 06/16/2015 M.A.Staff Time 7.50 210.00 210.00 Kimberly Pride 06/16/2015 MD Staff Time 6.00 1,050.00 1050.00 Dr.Fagan 06/17/2015 R.N.Staff Time 5.50 341.00 _ _ 341.00 Mareesa Martin 06/17/2015 M.A.Staff Time 5.50 154.00 I 154.00 Kimberly Pride 06/17/2015 MD Staff Time 5.00 875.00 875.00 Dr.Fagan 06/18/2015 R.N.Staff Time 4.50 279.00 279.00 Mareesa Martin i I Invoice# 742766(continued)page 3 I Service Date Description Quanti Charge Recei Ad"us Balance 06/18/2015 M.A.Staff Time 4.50 126.00 126.00 Kimberly Pride 06/18/2015 MD Staff Time 4.00 700.00 700.00 Dr.Fagan 06/19/2015 R.N.Staff Time 5.50 341.00 341.00 Mareesa Martin 06/19/2015 M.A.Staff Time 5.50 154.00 154.00 Kimberly Pride 06/19/2015 MD Staff Time 5.00 875.00 875.00 Dr.Fagan 06/22/2015 N.P.Staff Time 5.00 560.00 560.00 Andrea Opsal 06/22/2015 R.N.Staff Time 5.50 341.00 341.00 Mareesa Martin 06/22/2015 M.A.Staff Time 5.50 154.00 154.00 Kimberly Pride 06/23/2015 N.P.Staff Time 6.00 672.00 672.00 - - Andrea Opsal 06/23/2015 R.N.Staff Time 7.50 465.00 465.00 Mareesa Martin 06/23/2015 M.A.Staff Time 7.50 210.00 210.00 Kimberly Pride 06/24/2015 N.P.Staff Time 5.00 560.00 560.00 Andrea Opsal 06/24/2015 R.N.Staff Time 5.50 341.00 341.00 Mareesa Martin 06/24/2015 M.A.Staff Time 5.50 154.00 154.00 Kimberly Pride 06/25/2015 N.P.Staff Time 4.00 448.00 448.00 Andrea Opsal 06/25/2015 R.N.Staff Time 4.50 279.00 279.00 Mareesa Martin 06/25/2015 M.A.Staff Time 4.50 126.00 126.00 Kimberly Pride 06/26/2015 N.P.Staff Time 5.00 560.00 560.00 Andrea Opsal 06/26/2015 R.N.Staff Time 5.50 341.00 341.00 Mareesa Martin 06/26/2015 M.A.Staff Time 5.50 154.00 154.00 Kimberly Pride 06/29/2015 MD Staff Time 5.00 875.00 875.00 i Dr.Fagan 06/29/2015 R.N.Staff Time 5.50 341.00 341.00 Serina Price 06/29/2015 M.A.Staff Time 5.50 154.00 154.00 Kimberly Pride 06/30/2015 MD Staff Time 6.00 1,050.00 j 1050.00 Dr.Fagan I I I I i Invoice# 742766(continued)page 4 I Service Date Description Quanti Charge Recein Ad'us Balance 06/30/2015 R.N.Staff Time 6.00 372.00 372.00 David Moran 06/30/2015 M.A.Staff Time 6.50 182.00 182.00 Kimberly Pride CITYCARO Invoice# 742766 Balance Due: 28394.00 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE INVOICE#ON CHECK „� j, Cut and return with payment /1 Indiana University Health Workplace Services, LLC 950 North Meridian Street Suite 950 —36) Indianapolis, IN 46204 317-963-1535 Tax ID# 20-0994452 Invoice June 30, 2015 Bill to: Barbara Lamb For: City of Carmel-Onsite City of Carmel-Onsite Onsite Fees/June 2015 1 Civic Square Carmel,IN 461032- Invoice# 742482 Service Date Desc,rintion Quanti Charge Receip Balance 06/01/2015 City of Carmel Sports Performance 1.00 1,800.00 1800.00 Lease 06/01/2015 City of Carmel Clinic Build Out 1.00 2,574.16 2574.16 CITYCARO Invoice# 742482 Balance Due: 4374.16 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE INVOICE#ON CHECK Submitted To JUL 13 2015 Clerk Treasurer i h �„ Cut and return with payment Indiana University Health Workplace Services, LLC 950 North Meridian Street Suite 950 (City of Carmel) —3O) Indianapolis, IN 46204 317-963-1535 Tax ID# 20-0994452 Invoice June 30, 2015 Bill to: Barbara Lamb For: City of Carmel-Onsite City of Carmel-Onsite Supply Billing/June 2015 1 Civic Square Carmel,IN 4 032- Invoice# 743002 Service Date DescriptionQuant! Charge Receipt AdLU-SA Balance 06/01/2015 Onsite Operating Supplies 1.00 1,424.86 1424.86 June 2015 Supplies I CITYCARO Invoice# 743002 Balance Due: 1424.86 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE INVOICE#ON CHECK I Submitted To JUL 13 2015 Clerk 'Treasurer i Cut and return with payment Indiana University Health Workplace Services,LLC 950 North Meridian Street Suite 950 (City of Carmel) Indianapolis, IN 46204 317-963-1535 Tax ID# 20-0994452 Invoice June 30, 2015 Bill to: Barbara Lamb For: City of Carmel-Onsite City of Carmel-Onsite Misc.Onsite/June 2015 1 Civic Square Carmel,IN 461032- Invoice# 743001 Service Date 1.00 2,745.34 2745.34 CITYCARO Invoice# 743001 Balance Due: 9852.20 MAKE PAYME TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE INVOICE#ON CHECK 112® Submitted To JUL 13 2015 Clerk Treasurer A Cut and return with payment Prescribed by State Board of Accounts City Forth No.201(Rev.199q ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL An invoice or bill to be xoperly itemized must show: kind of service, where performed, dates service rendered, by whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc. Payee IU Health Workplace Services LLC � Purchase Order No. i i Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 06/30/15 742766 Ons-ite Staff Time!june 2015 06/30/1 une28,394.00 4,374.16 06/30/15 74.';no Onliste Supply Billing!june 2815 1,424.86 06/3 150.00 06/ 9,702.20 i I Total 44,045.22 I hereby certify that the attached invoice(s), or bill(s), is (are)true and correct and I have audited same in accor- dance with IC 5-11-1011.6. 20 Clerk-Treasurer VOUCHER N007/13/15 WARRANT NO. •t � ALLOWED 20 IU Health Workplace Services, LLC; IN SUM OF $ 2046 Reliable Pkwy Chicago, IL 60686-0020 $ 44,045.22 ON ACCOUNT OF APPROPRIATION FOR l 301 Medical Fund Board Members I Po#or INVOICE NO. ACCT#/TITLE AMOUNT DEPT.# I hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and that the materials or services itemized thereon 742766 301 $28,394.00 for which charge is made were ordered and 742482 30 $4,374.16 i received except 743002 Ani $1,424.86 11:20 7AAnni— 407 04I i i I 20 I f Signature Cost distribution ledger classification if I Title claim paid motor vehicle highway fund Indiana University Health Workplace Services, LLC 950 North Meridian Street i Suite 950 (City of Carmel) Indianapolis, IN 46204 317-963-1535 Tax I D# 20-0994452 Invoice I June 30, 2015 Bill to: Barbara Lamb For: City of Carmel-Onsite City of Carme�-Onsite Onsitedune 2015 1 Civic Squarel Carmel,IN 46032- Invoice# 742554 Service Date Description Quanti Charae Recei Aw—usat Balance 06/16/2015 Quick Read UDS/6panel includes INCLUDE INVOICE#ON CHECK Cle A Cut and return wide payment , VOUCHER NO. WARRANT NO. ALLOWED 20 IU Health Workplace Services, LLC IN SUM OF $ 4 2046 Reliable Pkwy Chicago, IL 60686-0020 $75.00 ON ACCOUNT OF APPROPRIATION FOR Carmel HR Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 1201 j 742554 43-588.00 $75.00 I hereby certify that the attached invoice(s), or bill(s) is (are)true and correct and that the materials or services itemized thereon for which charge is made were ordered and received except Monday, July 13, 2015 Director, HR Title Cost distribution ledger classification if claim paid motor vehicle highway fund Prescribed by State Board of Accounts City Form No.201(Rev.1995) ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL An invoice or bill to be properly itemized must show: kind of service,where performed,dates service rendered, by whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc. Payee Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s)or bill(s)) 06/30/15 742554 Testing $75.00 I hereby certify that the attached invoice(s), or bill(s), is(are)true and correct and I have audited same in accordance with IC 5-11-10-1.6 120 Clerk-Treasurer Ll �s Indiana University Health Workplace Services, LLC 950 North Meridian Street Suite 950 (City of Carmel) Indianapolis, IN 46204 317-963-1535 Tax I D# 20-0994452 I Invoice June 30, 2015 Bill to: Barbara Lamb For: City of Carmel-Onsite City of Carmel-Onsite EAP Services/June 2015 1 Civic Square Carmel,IN 46032- Invoice# 743083 I Service Date Description Quanti Charge Recelp Ad us Balance 06/01/2015 EAP Services 588.00 705.60 705.60 CITYCARO Invoice# 743083 Balance Due: 705.60 MAKE PAYMENT TO THE BELOW ADDRESS WITHIN 30 DAYS OF INVOICE DATE-PLEASE INCLUDE INVOICE#ON CHECK _ I Submitte0 JUL 13 2015 Clerk Ti easurer i I ; Cut and returnwith payment VOUCHER NO. WARRANT NO. ALLOWED 20 IU Health Workplace Services, LLC IN SUM OF$ 2046 Reliable Pkwy Chicago, IL 60686-0020 $705..-60 ON ACCOUNT OF APPROPRIATION FOR Administration Department PO#/Dept. INVOICE NO. ACCT#lrITLE AMOUNT Board Members 1205 I 743083 I 43-475.00 I $705.60 1 hereby certify that the attached invoice(s), or bill(s) is (are)true and correct and that the materials or services itemized thereon for which charge is made were ordered and received except Monday, July 13, 2015 Director, Administration 'i Title Cost distribution ledger classification if claim paid motor vehicle highway fund Prescribed by State Board of Accounts City Form No.201(Rev.1995) ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL An invoice or bill to be properly itemized must show: kind of service,where performed,dates service rendered, by whom, rates per day, number of hours, rate per hour, number of units, price per unit,etc. Payee Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s)or bill(s)) 06/30/15 743083 EAP Services $705.60 I hereby certify that the attached invoice(s),or bill(s), is(are)true and correct and I have audited same in accordance with IC 5-11-10-1.6 20 Clerk-Treasurer